Department of Veterans Affairs
PBM Drug Accountability Conference
San Antonio, TX
May 11 - 13, 2010
VA Consolidated Mail Outpatient Pharmacy
Stephen J. Lewis RPh
Associate Director
Murfreesboro, TN
Department of Veterans Affairs
Consolidated Mail Outpatient Pharmacy
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Department of Veterans Affairs
Consolidated Mail Outpatient Pharmacy
CMOP Mission
To serve veterans through the safe,
cost-effective, timely and efficient fulfillment of
prescriptions in support of the provision of care.
CMOP Vision
Partner
with VA Medical Center customers in the provision of integrated and seamless care
Continuously
Ensure
improve quality processes and service provided
the highest level of integrity and accountability
Contribute
as members of VA Pharmacy community
Contribute
as members of the Pharmacy Profession
Be
a “visible” component yet a transparent presence in the patient-centric pharmacy process
Continuously
Innovate,
plan and prepare for response to emergent need both locally and nationally
Automate, and Transform the provision of Prescription Benefit to veterans
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



Initial review of the order
Medication profile review
Patient consultation
Verification of patient
address
Daily transmission of orders
Reporting of errors and
patient complaints
Notification of changes in
product utilization
Medical Center






Verification of order
transmissions
Accurate and timely
processing of orders
Investigation, trending, and
feedback for all errors and
patient complaints reported
Cancellation of order with
explanation to the Medical
Center, when applicable
Proper inventory control
Provision of cost reports
CMOP
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Life of a VA CMOP
Mail Outpatient Prescription
Provider Orders
Medication/Supplies
1+ Hrs
Patient Receives
Medication/Supplies
10 Hrs
Awaiting Order
Verification by VAMC
12 to 48 Hrs
48+ Hrs
CMOP
Filling
Awaiting Transmission
of Order to CMOP
Delivery of Product
to Patient
Goal: delivery to patient within 10 days of provider or patient request
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Tablet/Capsule Dispensers (16%)
Baker and Others
Unit of Use Dispensers (70%)
Knapp and SI Dispen-SI-Matic
• Highest efficiency with fewest errors
Automatic tablet/capsule counting
 Improved tablet/capsule delivery to
eliminate miscounts

Controlled Substances (6%)
ADU, AutoMed-Fast Fill, and Others
• Accurate automated counting
• Complete inventory every 24 hrs
Outsource Contractors (1%)
Bulk Dispensing (4%)
• Special shipping needs
Manual Dispensing (3%)
• Low use products
Medline and McKesson


Large, heavy, or bulky non-drug products
Data security compliant with VA standards
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7
Snapshot
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10
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Address hygiene. Incorrect addresses are a
cost to all, from destruction of drug costs, to
return to shipper costs for certain packages.
$180M per year on shipping alone.
◦ For example, at Mid-South CMOP over the last six
months over 8,100 packages have been returned.
This is just controls.






3,824 Unclaimed
1,779 Address issues
1600 Three attempts made
336 Refused
203 Deceased.
Etc…
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
Knowing what’s on the CMOP formulary.
◦ Low use cancel backs. Do you really want to unmark them?
◦ Running Pro-Clarity routine to determine products
that could reach CMOP MOU threshold.
◦ Contacts at your local CMOP for product addition.
 //vaww.apps.cmop.va.gov/CMOPProductLine/
◦ Know your local transmit to CMOP time.
◦ Know your station number.
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November
December
January
February
March
001 TEMP OUT OF STOCK-OTHER
11.93%
9.99%
9.02%
12.47%
20.93%
20.70%
002
CMOP STOCKS ALTERNATE PACK SIZE:
8.58%
6.31%
5.89%
4.26%
4.99%
6.66%
003
NOT STOCKED IN CMOP-LOW USAGE
1.58%
1.17%
1.01%
1.10%
1.56%
3.20%
004
QTY EXCEEDS DAYS SUPPLY
0.93%
0.66%
0.71%
0.67%
0.88%
1.23%
005
NDF CHANGE-REMATCH
1.75%
0.79%
0.36%
0.21%
0.34%
0.91%
006
PRODUCT DISCONTINUED
0.76%
1.45%
0.79%
0.75%
0.60%
0.55%
007
MANUFACTURER'S BACKORDER
27.99%
37.23%
50.39%
60.55%
48.38%
43.06%
008
MAILING ADDRESS PROBLEM
0.38%
0.15%
0.17%
0.16%
0.34%
0.30%
009
DUPLICATE RX IN ORDER
0.06%
0.15%
0.02%
0.04%
0.02%
0.03%
010
ABBREVIATION/MISSPELLING IN SIG
0.65%
1.47%
1.84%
1.94%
1.82%
2.99%
011
EXPIRED ADDRESS CORRECT & RESUBMIT
0.06%
0.37%
0.97%
0.52%
0.56%
1.66%
012
SITE REQUESTED CANCEL
2.05%
1.46%
1.40%
1.22%
1.21%
4.00%
013
TEMP OUT OF STOCK-PRIME VENDOR
3.80%
1.34%
5.44%
5.43%
8.62%
2.65%
014
SIG TO LONG TO PROCESS
1.24%
1.05%
1.07%
0.96%
1.03%
1.44%
015
REFRIGERATED ITEM TO PO BOX FILL LOCALLY
1.27%
1.29%
1.40%
1.36%
1.52%
2.14%
016
BAD ZIP CODE FOR ADDRESS/STATE
0.01%
0.03%
0.04%
0.05%
0.06%
0.04%
017
NOT STOCKED CONTACT CMOP WITH USAGE
0.20%
0.38%
0.64%
0.69%
0.80%
1.08%
018
CORRECT QTY & RESUBMIT
1.43%
0.99%
1.71%
1.16%
1.02%
1.88%
019
SPECIAL NEED PATIENT-FILL LOCALLY
0.01%
0.01%
0.00%
0.00%
0.01%
0.01%
020
DATABASE ERROR-PLEASE RESUBMIT
0.53%
0.31%
0.25%
0.15%
0.22%
0.47%
021
COULD NOT FILL IN DESIGNATED TIMEFRAME
1.26%
5.34%
7.71%
3.17%
3.07%
2.24%
022
PLEASE VERIFY DOSE
0.13%
0.11%
0.08%
0.09%
0.14%
0.15%
023
QUESTION/CONFUSION ON SIG
0.55%
0.34%
0.59%
0.28%
0.37%
0.48%
024
DUPLICATE DRUG THERAPY
0.09%
0.04%
0.05%
0.06%
0.06%
0.04%
025
DRUG RECALL BY MANUFACTURER
0.13%
0.03%
0.01%
0.00%
0.03%
0.01%
026
VERFY DRUG/DOSAGE IF CORRECT ADD ###
0.15%
0.07%
0.06%
0.05%
0.04%
0.08%
027
OTHER:
1.14%
0.67%
7.36%
1.75%
0.46%
0.75%
028
0.00%
0.02%
0.05%
0.04%
0.04%
0.04%
029
0.02%
0.74%
0.90%
0.77%
0.81%
0.96%
Cancel Reason
Cancel
Report
by
Percent
of Total
FY10
Quarter 2
October
Quarter 1
030
0.00%
0.00%
0.00%
0.00%
0.00%
0.15%
All Other codes
31.31%
26.07%
0.07%
0.09%
0.06%
0.10%
98,999
150,233
224,617
202,358
177,806
156,944
CMOP Total Cancels
Top 10 Manufacturer Back Orders
# Rx
FLUNISOLIDE 0.025% 200D NASAL INH SPRAY
16328
GEMFIBROZIL 600MG TAB
12235
FLUNISOLIDE 25MCG 200D NASAL INH
SPRAY
3593
TRAZODONE HCL 100MG TAB
3519
SIMVASTATIN 20MG TAB
2814
ACYCLOVIR 200MG CAP
2251
PRAZOSIN HCL 2MG CAP
2225
PENTOXIFYLLINE 400MG SA TAB
1832
DOXAZOSIN MESYLATE 8MG TAB
1573
ALENDRONATE 70MG TAB
1405
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
Just in Time
products:
◦ Do you know what products
your CMOP has as Just in Time?
◦ Can you utilize that process for
your patients?
 Lowers local inventory
holding cost and risks.
 Usually overnight/next day
service to the patient from
the CMOP.
 May in fact get to the patient
at the same time local VA
could get it to the patient.
Prod
Code
Pack
Size
NDC
Product
A1223
1.00
00173074200
ABACAVIR SO4
600MG/LAMUVI
DINE
A1525
1.00
00003362412
ATAZNAVIR
150MG CAP
A1526
1.00
00003363112
ATAZNAVIR
200MG CAP
A1527
1.00
00003362212
ATAZNAVIR
300MG CAP
D0794
1.00
59676056101
DARUNAVIR
ETHANOLATAE
400MG TAB
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
Med/Surg Items
and Low Use Items.
◦ What does your
CMOP carry?
◦ Are your items
turned on?
◦ Are you ordering the
correct pack size?
◦ Does your drug file
reflect CMOP pk size?
Product VA
Code
Print
Name
Dispens Max
ing
Dispens
Pack
e QTY
Size
Outsou
rce
Catalog
Numbe
r
A0120
ALCOH 480
OL
ISOPRO
PYL
70%
48
PDL574
005716
H
A1016
ALLCLE 360
NZ TOP
SPRAY
12
HLP213
020012
H
A1020
ALOE
240
VESTA
PROTEC
TIVE
TOP
OINT
8
SQ3249
08H
BO580
BARRIE
R
H1480
3
12
HTP148
03
5
18
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